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Utah rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $123 · 10th–90th $89–$1450%50%10th90th$123Professionalmedian $117 · 10th–90th $107–$3390%20%10th90th$117$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $117.49 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $125.89 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $107.15 / $165.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $141.25 / $169.82
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $114.82 / $257.04
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $169.82 / $269.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89